Diana Matceyevsky

Patterns of Failure after Stereotactic Radiosurgery of the Resection Cavity Following Surgical Removal of Brain Metastases

BACKGROUND Whole brain radiation treatment (WBRT) is considered standard treatment for BM. However, exposing large volumes of normal brain tissue to irradiation can cause neurotoxicity. This study describes our experience with 100 consecutive patients with brain metastases who were managed with surgical extirpation followed by stereotactic radiosurgery (SRS) to the resection cavity. METHODS Patients with 1-3 brain metastases (BM), who underwent resection of 1-2 BM between June 2005 and December 2013, were treated with SRS directed to the tumor cavity and for any synchronous BM. Local and distant treatment failures were determined based on neuroimaging. Kaplan-Meier curves were generated for local and distant failure rates and overall survival. RESULTS One hundred and two resection cavities were treated with SRS in 100 consecutive patients. Thirty-two additional synchronous metastases were treated in 27 patients during the same session. The median overall survival was 18.9 months. Local control rate at 1 year was 84%. Longer delays between surgery and SRS were associated with increased risk of local failure (hazard ratio, -1.46; P = 0.02). Distant progression occurred in 44% of the patients at a mean of 8.8 ± 6.6 months after SRS treatment. Ten cases of leptomeningeal spread occurred around the resection cavities (9.8%). Central nervous system failure was not significantly associated with survival. Multivariate Cox regression analysis showed that recursive partitioning analysis and active systemic disease were significantly associated with survival. CONCLUSION The strategy described provides acceptable local disease control when compared with WBRT following surgery. This approach can delay and even annul WBRT in the majority of selected BM patients, especially recursive partitioning analysis class I patients. SRS should be scheduled as soon as possible after surgery.

ErbB4 expression in squamous cell carcinoma of the head and neck

This study set out to delineate ErbB4 overexpression and its impact on prognosis in squamous cell carcinoma (SCC) of head and neck (H&N) origin. Thirty-six of the 47 evaluated SCC of H&N origin came from the larynx, oropharynx, or oral cavity. Twenty-four patients had stage III–IV, 17 had stage I–II, and 6 had recurrent disease. Immunohistochemical stains were performed on paraffin sections using the avidin–biotin–peroxidase method. Forty-five patients received radiation therapy, 24 primary treatment and 21 postoperatively. Nineteen patients with advanced stage disease received concomitant chemotherapy. ErbB4 was highly stained in 24/47 (51%) patients and weakly stained in another 13/47 (28%) patients. Age, gender, site, stage, and treatment approaches similarly distributed between the groups. Overall survival (OS) and disease-free survival (DFS) were similar in ErbB4-positive and ErbB4-negative groups. In conclusion, although ErbB4 is not a prognostic parameter for OS and DFS in H&N SCC, it is highly overexpressed. The high overexpression rate may lead to initiation of anti-ErbB4 targeted therapy in this cohort of patients.

Phase II study of maintenance carboplatin in patients with advanced epithelial ovarian cancer after complete response to platinum based combination

5122 Background: Five years survival of patients with advanced epithelial ovarian cancer (EOC) is 25-40% and once the disease recurs, treatment is mainly palliative. We evaluated whether continued treatment with carboplatin for an extended one-year period in women with complete response after platinum based combination, could prolong time to progression (TTP) and overall survival (OS). METHODS 14 patients were assigned to the protocol between 2/1996 to 6/2002 at the Oncology Division in Tel Aviv Sourasky Medical Center. Protocol schedule was: administration of Carbopltin at an AUC=6, three treatments every 2 months followed by two treatments once every three months (for a total of one year). All patients were previously treated with platinum based combinations and had achieved complete response (CR) by CT-scan and serum CA-125. RESULTS As of December 2003 with a median follow up of 42 months (range 18-93 months), the median TTP is 28 months (range 8-93+ months), and a median OS of 42 months (range 18-93+ months). Eight patients are still in complete remission and two more patients are still alive with disease. CONCLUSIONS One year treatment (5 cycles) of single agent carboplatin that was administered to women with advanced EOC who achieved CR on platinum based chemotherapy as a first line, significantly prolonged TTP and OS compared to historical control. No significant financial relationships to disclose.